The Clinical Psychology Training Program at the University of Nebraska–Lincoln

The Clinical Psychology Training Program (CPTP) at the University of Nebraska–Lincoln (UNL) has been continuously accredited by the American Psychological Association (APA) since 1948, the first year any programs were accredited. The CPTP’s history and approach to training through the years have been described in numerous articles (DiLillo & McChargue, 2007; Hargrove, 1991; Hargrove & Howe, 1981; Hargrove & Spaulding, 1988; Hope, Hansen, & Cole, 1994; Howe, 1974; Howe & Neimeyer, 1979; Jones & Levine, 1963; Rivers & Cole, 1976). Our program was historically described as a “Community-Clinical” psychology training program, and this focus on understanding and enhancing well-being at the individual, family, and community levels continues to be valued in our program today across a variety of clinical and research activities. The CPTP has followed the scientistpractitioner, Boulder-model of clinical training since its inception. Our Director of Clinical Training in 1949, Marshall Jones, was a participant in the Boulder Conference on Graduate Education in Clinical Psychology. Both clinical and research training are continuous, integrated processes in the CPTP, continuously supervised and monitored by the clinical faculty. The CPTP subscribes to the APA evidence- based practice model (APA, 2006) across all of our clinical training. Integration of EBP into our scientist-practitioner curriculum was highlighted in a special issue of Journal of Clinical Psychology that focused on EBP training (DiLillo & McChargue, 2007). Students in the CPTP are trained to be both consumers and producers of research, applying best research evidence in clinical practice and generating new knowledge to improve treatment. Within this EBP framework our emphasis is on behavioral and cognitive behavioral therapies. The department made an active decision, beginning in 1990, to hire scientist- practitioner faculty members with a behavioral or cognitive-behavioral orientation. The core clinical faculty provide clinical and research training in behavioral and cognitive-behavioral therapies, third-generation cognitive-behavioral approaches (e.g., mindfulness and acceptance-based), motivational enhancement approaches, and, to a lesser degree, family systems. The CPTP was honored to receive the 2013 ABCT Outstanding Training Program Award. The award is given for “significant contribution to training behavior therapists and/or promoting behavior therapy.

Serotonin reuptake inhibitors in pregnancy : can genes help us in predicting neonatal adverse outcome?

Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome. So far, still little is known about the possible etiologic mechanism that could not only explain the adverse neonatal effects but also the degree of clinical involvement and presentation in the early period after birth. Pharmacogenetics and moreover pharmacogenomics, the study of specific genetic variations and their effect on drug response, are not widespread. This review describes possible relationship between SSRIs pharmacogenetics and different neonatal outcomes and summarizes the current pharmacogenetic inquiries in relation to maternal-foetal environment

Dietary Intakes and Nutritional Issues in Neurologically Impaired Children

Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children

Utility of magnetic resonance imaging in the follow-up of children affected by acute osteomyelitis

Acute osteomyelitis is characterized, especially in children, by high morbidity due to extension of the infectious process or its chronicization. No guidelines exist for the post-discharge follow-up of children affected by acute osteomyelitis, especially regarding the utility of magnetic resonance imaging (MRI). To investigate if MRI is useful in the follow-up of AO pediatric patients. We reviewed medical records and MRI studies of children admitted to our Pediatric Department for acute osteomyelitis from 2008 to 2015. All children who had a follow-up MRI performed at least 10 days after diagnosis were included in the study. We analyzed if MRI follow-up prompted a change in patients\u2019 treatment. A total of 28 MRI studies were performed in 27 children (13 males and 14 females). Infection involved the appendicular skeleton in 64.3% of patients. Five (18%) of these studies prompted a change in patients\u2019 treatment. The only statistically significant indication for change in the therapeutic approach was MRI performed for persistence or worsening of the disease (p=0.0058). Change in bone signal at MRI, and time interval (more or less than 28 days) between MRI at diagnosis and at follow-up were not significantly associated with change in the patients\u2019 treatment (p=0.40; p=0.40, respectively). Routine MRI follow-up is not useful in children affected by acute osteomyelitis who adequately respond to antibiotic treatment. It can be useful, in adjunct to clinical evaluation, in non-responders patients. Clinical monitoring remains the mainstay in the follow-up of these patients

Gluten free diet in children: an approach to nutritionally adequate and balanced diet

Gluten-free diet.(GFD) is the cornerstone treatment for celiac disease (CD). GFD implies a strict and lifelong elimination from the diet.of gluten, the storage protein found in wheat, barley, rye and hybrids of these grains, such as kamut and triticale. The absence of gluten in natural and processed foods, despite being the key aspect of GFD, may lead to nutritional consequences, such as deficits and imbalances. The nutritional adequacy of GFD is particularly important in children, this the age being of maximal energy and nutrient requirements for growth, development and activity. In recent years, attention has focused on the nutritional quality of gluten-free products (GFPs) available in the market. It is well recognized that GFPs are considered of lower quality and poorer nutritional value compared to the gluten-containing counterparts. The present review focuses on the nutritional adequacy of GFD at the pediatric age, with the aim being to increase awareness of the potential complications associated with this diet. to identify strategies in order to avoid them and to promote a healthier diet.and lifestyle in children with CD

Nutritional status in neurologically impaired children and its relation with bone mineralization

Objectives and study: Malnutrition and low bone mineral density (BMD) are common in neurologically impaired (NI) children, in particular in children with cerebral palsy (CP). The two conditions are related, as it is known that poor nutritional status can negatively impact on bone mineralization. The aim of our study was to assess nutritional status, bone health and the relation between the two conditions in our population of NI children. Methods: A total of 26 NI subjects (mean age 9,9 + 3,7 years, M:F ratio 11:15, all Caucasian except for one Hispanic), were enrolled between November 2014 and March 2015. Diagnoses were: cerebral palsy (CP) 42.3% (n=11), epilepsy of various etiology associated with mild or no motor impairment (epilepsy without CP) 57.7% (n=15). Patients receiving vitamin D supplementation were excluded. All subjects underwent: 1) Nutritional assessment including feeding history, anthropometric evaluation of weight, height, body mass index (BMI) and triceps skinfold thickness (TST); 2) Biochemical analyses for bone metabolism and serum markers of bone turnover including parathormone (PTH), 25-hydroxy-vitamin D (25OHvitD), bone alkaline phosphatase (BAP) and carboxy-terminal collagen (CTX); 3) BMD measurement at lumbar spine (L1-L4) with Dual Energy X-ray Absorptiometry (DEXA). Results: Feeding difficulties were encountered in 42.3% of total patients, in 90,9% of children with CP. Nutrient intakes were compared to recommended dietary intakes for Italian population (LARN 2014), insufficient intake of energy, protein and calcium were found in 26,9%, 3.8%, 69,2% of total patients. A poor nutritional status (BMI< 10th c.le and/or TST< 10thc.le) was found in 38,5% of total patients, in 72,7% of children with CP. Vitamin D insufficiency (25OHvitD < 20 ng/dl) was found in 65,4% of total subjects, in 81,8% of children with CP. Values of CTX and BAP were significantly higher in epileptic children without CP compared to children with CP (p=0,0396 and 0,048 respectively). Results of nutritional status and bone metabolism are shown in table 1. A poor bone mineralization (BMD z-score < 2) was found in the lumbar spine of 38% of the total and in 73% of children with CP. Correlation analyses found positive correlation between BMD z-score and the anthropometric parameters BMI z-score and TST (r=0.8205; p< 0,0001 and r=0.7374; p< 0,0001 respectively). Negative correlation was also found between BMD z-score and severity of motor impairment measured by Gross Motor Function Classification Scale- GMFCS (r= -0,7216 p< 0,05). Conclusion: Our data confirm a high prevalence of malnutrition, vitamin D insufficiency and poor bone mineralization in NI children, particularly in those with CP. We also confirm that nutritional status and motor impairment are factors that negatively impact on bone mineralization. Disclosure of interest: None declared

Stalking influenza by vaccination with pre-fusion headless HA mini-stem.

Inaccuracies in prediction of circulating viral strain genotypes and the possibility of novel reassortants causing a pandemic outbreak necessitate the development of an anti-influenza vaccine with increased breadth of protection and potential for rapid production and deployment. The hemagglutinin (HA) stem is a promising target for universal influenza vaccine as stem-specific antibodies have the potential to be broadly cross-reactive towards different HA subtypes. Here, we report the design of a bacterially expressed polypeptide that mimics a H5 HA stem by protein minimization to focus the antibody response towards the HA stem. The HA mini-stem folds as a trimer mimicking the HA prefusion conformation. It is resistant to thermal/chemical stress, and it binds to conformation-specific, HA stem-directed broadly neutralizing antibodies with high affinity. Mice vaccinated with the group 1 HA mini-stems are protected from morbidity and mortality against lethal challenge by both group 1 (H5 and H1) and group 2 (H3) influenza viruses, the first report of cross-group protection. Passive transfer of immune serum demonstrates the protection is mediated by stem-specific antibodies. Furthermore, antibodies indudced by these HA stems have broad HA reactivity, yet they do not have antibody-dependent enhancement activity

The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID-19: a 6-months prospective study

Objectives: To perform a comprehensive clinic, laboratory, and instrumental evaluation of children affected by coronavirus disease (COVID-19). Methods: Children with a positive result of nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underwent laboratory tests, anal and conjunctival swab, electrocardiography, lung, abdomen, and cardiac ultrasound. Twenty-four-hour ambulatory blood pressure monitoring was performed if abnormal basal blood pressure. Patients were followed-up for 6 months. Results: Three hundred and sixteen&nbsp;children were evaluated; 15 were finally included. Confirmed family member SARS-CoV-2 infection was present in all. Twenty-seven percent were asymptomatic. Anal and conjunctival swabs tests resulted negative in all. Patients with lower body mass index&nbsp;(BMI) presented significantly higher viral loads. Main laboratory abnormalities were: lactate dehydrogenase increasing (73%), low vitamin D levels (87%), hematuria (33%), proteinuria (26%), renal hyperfiltration (33%), and hypofiltration (13%). Two of the patients with hyperfiltration exhibited high blood pressure levels at diagnosis, and persistence of prehypertension at 6-month follow-up. No abnormalities were seen at ultrasound, excepting for one patient who exhibited B-lines at lung sonography. Immunoglobulin G seroconversion was observed in all at 1-month. Conclusions: Our study confirm that intra-family transmission is important. The significant higher viral loads recorded among patients with lower BMI, together with low vitamin D levels, support the impact of nutritional status on immune system. Renal involvement is frequent even among children with mild COVID-19, therefore prompt evaluation and identification of patients with reduced renal function reserve would allow a better stratification and management of patients. Seroconversion occurs also in asymptomatic children, with no differences in antibodies titer according to age, sex and clinical manifestations

Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment : A Systematic Review

Nutrition is involved in several aspects of pediatric inflammatory bowel disease (IBD), ranging from disease etiology to induction and maintenance of disease. With regards to etiology, there are pediatric data, mainly from case-control studies, which suggest that some dietary habits (for example consumption of animal protein, fatty foods, high sugar intake) may predispose patients to IBD onset. As for disease treatment, exclusive enteral nutrition (EEN) is an extensively studied, well established, and valid approach to the remission of pediatric Crohn's disease (CD). Apart from EEN, several new nutritional approaches are emerging and have proved to be successful (specific carbohydrate diet and CD exclusion diet) but the available evidence is not strong enough to recommend this kind of intervention in clinical practice and new large experimental controlled studies are needed, especially in the pediatric population. Moreover, efforts are being made to identify foods with anti-inflammatory properties such as curcumin and long-chain polyunsaturated fatty acids n-3, which can possibly be effective in maintenance of disease. The present systematic review aims at reviewing the scientific literature on all aspects of nutrition in pediatric IBD, including the most recent advances on nutritional therapy